Approach to cough

Approach to cough

1. Cough is an explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree of secretions and foreign material.

2. The bronchi and trachea are so sensitive to light touch that excessive amounts of foreign matter or other causes of irritation initiates the cough reflex.

3. Mechanism

4. MECHANISM OF COUGH How Do We Cough_ - The Mechanism of Coughing - Cough Reflex Animation - Learn Human Body.mp4

5. Thus.. From the mechanism.. Presence of significant COUGH- irritation of cough receptors..

6. D/D Onset- sudden onset after choking episode- foreign body, recurrent- atopic type, chronic- TB, bronchiectasis Productive- older children with early morning severe expectoration- Bronchiectasis , non-productive and only when awake- habitual Character- Barking- croup, spasmodic- atopic type Variation- nocturnal and early morning- atopic type, lying down- GERD

7. ETIOLOGY

8. CAUTION Pneumonia- involves parenchyma Cough receptors may not be involved in the early stages Hence cough may be a late feature of lobar pneumonia- Fever with tachypnea +/- retractions is diagnostic of pneumonia

9. SPUTUM Productive cough: significant amount of sputum; Blood- hemoptysis; smell- putrid smell- lung abscess Color of sputum- no bearing on the diagnosis Large amounts:- a)regular coughing up- bronchiectasis b)Single occasion-lung abscess,empyema c)Pink frothy-Pulmonary edema

10. PURULENT SPUTUM

11. RUSTY SPUTUM

12. BLOODY SPUTUM

13. 1.Diurnal variation Cough which gets worse in night and early morning :- Asthma 2.Postural variation Bronchiectasis, Lung abscess Lying down- postnasal drip, GERD, cardiac cause- pulmonary congestion 3.Seasonal variation Asthma, C/c bronchitis

14. Aggravating & Relieving factors Cold,smoke,dust,exertion: asthma Cough and choking on swallowing of liquids: Neuromuscular disorders- affects swallowing Solids- Oesophageal motility problems Otogenic cough: impacted wax or foreign body in external auditory meatus - subsides with removal of cause

15. Associated symptoms Fever: Pneumonia, lung abscess- clubbing also+ Chest pain: Pneumonia with pleuritis Pleuritic chest pain: lateral part of chest with associated splinting- increases on deep inspiration/ cough- Pleurisy, pleural effusion, bronchiectasis Frequent hawking of throat, Nasal discharge, snoring, tickling sensation in throat- Post nasal drip Cough with associated dyspnea on exertion/ palpitations- Cardiac cause

16. Stridor: FB, Laryngeal nerve involvement Hoarseness of voice: Laryngeal nerve involvement Heart burn, regurgitation: GERD

17. .Laryngeal inflammation:-cough, hoarseness of voice,stridor .FB:-cough,stridor,history .WHOOP SOUND- pertussis ALL DAY NEVER DURING SLEEP-habit cough

18. INFANT WITH WHOOPING COUGH My Movie.wmv

19. BABY WITH CROUP STRIDOR BARKING COUGH My Movie 2.wmv

20. .Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat .GERD:- cough,heart burns, regurgitation

21. 6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature

22. APPROACH TO TUBERCULOSIS

23. APPROACH IN CHILD